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BRIEFJune 20, 2022

Workshop identifies gender constraints to Universal Health Coverage in East Asia and Pacific

Gender workshop AUHC MDTF at DFAT, Canberra, Australia

Participants at the gender workshop in Canberra and online.

World Bank

Exploring how to address gender inequality while promoting progress towards universal health coverage was the focus of an Advance Universal Health Coverage (Advance UHC) trust fund workshop for East Asia and Pacific (EAP) countries in April. The event was a valuable opportunity for participants to reflect on issues that they have encountered working on projects across the region, and to propose strategies for resolving them.

The one-day event was co-hosted by the Australian Department of Foreign Affairs and Trade and the World Bank which are working together to advance UHC was well as the rights of women and girls in EAP. Participants at the workshop included 42 gender experts and managers from the two agencies, their country counterparts, and team members working in Cambodia, Lao PDR, Myanmar, Vietnam, Indonesia, Papua New Guinea and the Solomon Islands.

Thematic areas covered

The workshop went over three thematic areas—building evidence to identify gender gaps through assessments and analysis; strengthening health information systems with gender perspectives; and integrating gender considerations in quality monitoring, performance-based financing, and COVID-19 response.

Country teams, at various stages of gender assessment and implementation of recommendations, relayed the progress, lessons learned and constraints of their activities. Government counterparts also provided valuable policy and institutional perspectives on the unique challenges facing gender equality in the health sector. The workshop identified strategies for moving forward including:

·      Use COVID-19 as an opportunity to spotlight gender gaps in access to health services, in the health workforce, and in the overall economic recovery. Attention should be drawn to the pandemic’s devastating consequences for women and girls who bear the greatest burden of the disruption to health systems—a 25% drop in coverage of essential services since COVID-19 struck. Political interest should also be leveraged to improve conditions for women in the health workforce. Since women constitute the majority of health workers, access to healthcare cannot occur without them. Empowering women and promoting gender equality is thus crucial to the overall economic recovery.

·      The winning formula for advancing gender equality is to assess gender gaps to come up with recommendations specific to the country, establish strong collaboration and dialogue on gender with development partners and government counterparts, and integrate gender considerations in the project design for sufficient resources and attention.

·      Health information is a critical entry point for measuring the magnitude of gender gap issues and identifying the key priorities of the country. Disaggregated data (by sex/age/location) is important information for governments and partners to have when planning how to make the delivery of health services more equitable.

·      Both bottom up and top-down approaches are required to move the needle on gender. Find key champions at the top to shape good gender sensitive policies. At the same time, support frontline workers who implement activities, and train mid-level management to address identified gender gaps. Or as World Bank participant Laura Rawlings put it: “Speak to the heart, speak to the head and work from the bottom up and from the top down.”

 

Speak to the heart, speak to the head and work from the bottom up and from the top down.
Laura Rawlings
World Bank

Examples from countries

The workshop also saw examples of some concrete gender work that has been done in countries that include:

·      Cambodia: The Health Equity and Quality Improvement Project (H-EQIP) Gender Assessment (2017) helped the Ministry of Health (MOH) to develop specific actions to improve gender responsiveness and informed the design of the Cambodia Nutrition Project (2019-26). The Gender Equality and Social Inclusion (GESI) study to analyze the health sector is being undertaken in 2021-22 as part of H-EQIP2 project preparation and feeds directly into the project design.

·      Lao PDR: Key recommendations from the Gender Equality and Health Equity Assessment (2020) were integrated into various aspects of the Health and Nutrition Service Access (HANSA) project design, including the setting up of the Gender and Equity Innovation Fund to further strengthen MOH’s capacity for implementing its Gender Action Plan.

·      Vietnam: The Gender and Ethnic Minorities Assessment (GEMA) is in progress, which will identify opportunities and gaps in strengthening gender responsiveness and inclusiveness in projects. The final report will be available end June 2022.

·      Papua New Guinea: The IMPACT Health Gender Assessment, that looks at both demand and supply side constraints for women to access health services, is being finalized through a wide range of consultations to prioritize the recommendations, which will be supported through the project and program of advisory services and analytics (PASA).

Conclusion

Participants at the gender workshop concluded that with such diversity in operating environments, cultural contexts and entry points across East Asia and the Pacific, there is a need for additional analytical work looking at what has been learnt and how to adapt it for different contexts. The workshop also identified critical areas including intersectionality of gender, disability, ethnicity, sexual orientation and gender identity; as well as inclusion barriers in national health insurance schemes, career advancement and leadership positions for female health workers. These will require greater investment and in-depth research to find practical ways forward.